Provider Demographics
NPI:1518288752
Name:FEASTER, SAFIYYAH NAFEESAH (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:SAFIYYAH
Middle Name:NAFEESAH
Last Name:FEASTER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E HARDEN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-3001
Mailing Address - Country:US
Mailing Address - Phone:336-792-1710
Mailing Address - Fax:336-542-2170
Practice Address - Street 1:115 E HARDEN ST STE 103
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253-3001
Practice Address - Country:US
Practice Address - Phone:336-792-1710
Practice Address - Fax:336-542-2170
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0086031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical